Pamela Schwartz, Director of Program Evaluation for Kaiser Permanente's Community Benefit, discusses community interventions, the changes that are taking place, and what impact those lifestyle modifications have within a community.
Kaiser Permanente, one of America's leading health care providers and not-for-profit health plans, has been creating change and tracking success of obesity-prevention efforts as part of its Community Health Initiatives to improve population health. Recent findings confirm that high-dose interventions in and around school settings make positive, measurable impacts on health behaviors.
With over 20 years of experience in public health, Pamela Schwartz joined Kaiser Permanente in 2001 and became part of the organization's Community Benefit Program in 2007 as the Director of Program Evaluation. In this position, Pamela directs multiple cross-site evaluations of Kaiser Permanente's Community Benefit efforts, including Community Health Initiatives for Healthy Eating and Active Living, or HEAL. This national effort improves health in Kaiser Permanente communities through multi-sectorial, place-based efforts focusing on environmental and policy change.
"Our programs aim for community-wide behavior change," says Pamela. "The idea is that together, these efforts will improve activity levels, nutrition and overall health."
Pamela's point that school environments are much easier to change than neighborhood environments is something that has resonated with our experience at Common Threads, and probably for so many other nonprofit organizations that provide in-school and after-school programming. All of us do our best to reach children at a time when we can get their attention -- at their schools. At Common Threads we are intentional about developing and fostering a connection with what's happening at schools and considering how to integrate these elements at home, around the dinner table and/or in backyard gardens. Pamela explained that Kaiser's interventions include creating healthy environments inside schools and within communities, such as swelling activity minutes during physical education classes and time slots that children walk or bike to school. Another intervention mentioned was vending machine reform.
Sean Kelly is co-founder of California-based HUMAN Healthy Vending, Helping Unite Man and Nutrition, a company committed to increasing access to healthy food and drinks through refrigerated vending machines stocked with granola bars, dried fruit, trail mix, organic juices, premium waters and more. "If you don't have access to healthy foods, nothing else matters," said Sean in a recent Mother Nature Network article.
In my recent piece, "Let's Get One Million Kids Cooking," I discussed how gang war and rash shootings exist in too many neighborhoods that Common Threads works in, particularly in underserved neighborhoods in Miami and Chicago. Within these communities, the violence is inescapable -- families may be unable to leave their homes without witnessing violence, and are struggling to make ends meet. According to the National Health and Nutrition Examination Survey conducted from 2007-2008, the obesity prevalence among children and adolescents in the United States has almost tripled since 1980; and "approximately 17 percent (or 12.5 million) of our nation's children and youths aged 2--19 years are obese," with children from low-income ethnically diverse communities presenting even higher rates of obesity.
The Centers for Disease Control and Prevention has identified many socio-environmental factors that greatly contribute to weight and obesity issues in children, including:
•"Lack of daily, quality physical activity in all schools": Sixty minutes per day of physical activity is recommended for children; in contrast to a 2009 study that indicates that only 33 percent of youths are attending daily physical education classes.
•Dwindling numbers of "safe and appealing" places in many communities "to play or be active"
•"Variation in licensure regulations among child care centers": It is important to model children's behaviors toward food at an early age, but not all states have regulations for day care centers relating to physical activity and healthy eating practices.
•"Limited access to healthy affordable foods": Depending upon a family's location (urban/rural) and socioeconomic status, healthy affordable foods are not readily available.
With the interventions that Kaiser is implementing and the programming that Common Threads and other nonprofits like Wellness in the Schools, Pilot Light, and Nurture are providing, children and their families receive skills that can last a lifetime. Cooking, meal planning, healthy eating habits, and increasing activity levels encourage positive results, including the improvement of overall health. Kaiser Permanente's evaluation has shown promising results since it launched its Thriving Schools effort, aimed at helping students, staff and teachers focus on making healthy choices so that schools can become a focal point and beacon of health throughout entire communities. Their findings, principles and strengths can be tailored and made functional for specific communities. Determining the successes, failures, and best practices, among many other aspects, all come into play when assessing evaluations.
Measuring body mass index (BMI), aerobic capacity and behavior changes are vital in Kaiser's evaluation process. Relying heavily on existing data from California's Physical Fitness Data Collection, students in California schools take a physical fitness test (PFT) called FITNESSGRAM as a tool to implement physical exercise as a life-long habit. Measuring BMI of children is a process that our team has always approached with sensitivity due to unintended consequences, like eating disorders and negative self-perceptions. I personally don't keep a scale in my own house.
"While BMI does not measure body fat directly, it is calculated using height and weight and many studies have shown it to be a reliable indicator of body fatness and disease risk," says Maggie Sommers, MS, RD, and Senior Director of Food and Nutrition Policy at Food Directions. "Best of all it is an inexpensive and simple method for determining whether a child's weight is healthy."
BMI-for-age-percentile growth charts are used to interpret BMI in boys and girls ages 2 to 20, which provide sufficient information to place the child in a weight category (underweight, normal, overweight, or obese). This information then allows health professionals to address each child's unique needs. Kaiser Permanente's approach has given me reason to pause regarding my perspective with their advancements showing successful interventions. Perhaps this is something we can all weigh in on and decide together if the pros outweigh the cons.